Oklahoma strategy for suicide prevention

OKLAHOMA STRATEGY FOR SUICIDE
PREVENTION
2011 Based on recommendations of the Oklahoma Suicide Prevention CouncilTHE OKLAHOMA STRATEGY FOR SUICIDE PREVENTION is dedicated to all Oklahomans who have experienced the tragedy of suicide and to the brave survivors.
The Oklahoma Suicide Prevention Council also dedicates this plan to the memory of Carol King, suicide survivor and advocate for suicide prevention in Oklahoma.
• • •| 1
Many individuals have dedicated time and energy to the development of the Oklahoma Strategy for Suicide Prevention. The Oklahoma Suicide Prevention Council acknowledges the following member and participating organizations for their commitment and support.
• • •
Aging Network
HeartLine
Indian Health Services
Long Term Care Authority
Minco Public Schools
Muscogee Creek Nation-Children’s Mental Health Initiative
Oklahoma Commission on Children and Youth
Oklahoma Department of Mental Health and Substance Abuse Services
Oklahoma Department of Veterans Affairs
Oklahoma Faith Communities
Oklahoma Mental Health and Aging Coalition
Oklahoma Office of Juvenile Affairs
Oklahoma State Department of Education
Oklahoma State Department of Health
Minco Public Schools
Survivors of Suicide
Tulsa Public Schools
University of Oklahoma
Youth Services for Oklahoma County
Youth Services of Tulsa
The Oklahoma Strategy for Suicide Prevention is purposefully and closely aligned with recommendations
of the National Strategy for Suicide Prevention, therefore the developers of this plan would like to
acknowledge the use of the National Strategy text throughout the document.
ACKNOWLEDGEMENTS2 |
COLLABORATION EFFORT
RESILIENCE | 3
Background
Resilience, strong will, collaboration, and effort are part of the fabric of our s tate’s history and citizenry. These characteristics were the driving force when a group of concerned Oklahomans first began gathering in 1997 to discuss the urgency and need to address the prevention of suicide. • • •
In 2001, the U.S. Department of Health and Human Services released the National Strategy for Suicide
Prevention, a comprehensive and integrated approach to reducing suicide and suicidal behaviors across
the life span. The national strategy is a culmination of efforts including the 1999 Surgeon General’s Call to
Action to Prevent Suicide and the landmark Mental Health: A Report of the Surgeon General (1999).
During the same time, a state plan to prevent youth suicide in Oklahoma was developed at the direction
of the Oklahoma Legislature. The plan was developed by a state task force created in 1999 by House
Joint Resolution No. 1018. Representatives from the task force presented on the development of
the Oklahoma plan at a public hearing in Atlanta, Georgia in 2000. The State Plan on Youth Suicide
Prevention was adopted in 2001 and the Oklahoma Youth Suicide Prevention Act was enacted, tasking a
new Youth Suicide Prevention Council to implement the plan.
Since 2001, the Oklahoma Youth Suicide Prevention Council has actively pursued opportunities to act
on the recommendations included in the state plan. The Council, comprised of suicide survivors, youth,
educators, mental health professionals, and state agencies, achieved two significant outcomes to advance
suicide prevention in the state. The first was making suicide a reportable injury so that hospitals reported
suicide attempts, greatly enhancing the state’s understanding of the scope of the problem. The second
major achievement was the state’s award of funds for youth suicide prevention and early intervention.
The Oklahoma Department of Mental Health and Substance Abuse Services was awarded federal
Garrett Lee Smith Youth Suicide Prevention and Early Intervention grant funding from the Substance
Abuse and Mental Health Services Administration for years 2005 to 2008, and then re-funded in 2008
through 2011. This funding allowed the state to begin implementation of several recommendations in the
state’s 2001 state suicide prevention plan, including statewide and community-based suicide prevention
training, suicide screening for youth and improved referral networks for youth at risk for suicide.
In 2008, the Council achieved another significant milestone when the Oklahoma Youth Suicide Prevention Act was amended by Senate Bill 2000 to become simply the Oklahoma Suicide Prevention Act, broadening the scope of the Council and the state plan to prevent suicide among Oklahomans of all ages. The Council and state Legislature recognized the need for a comprehensive strategy for Oklahoma citizens.
INTRODUCTION4 |
Purpose of Oklahoma’s Suicide Prevention Strategy
• • •
The Oklahoma Suicide Prevention Council recognizes suicide as a public health problem and proposes
strategies based on public health methods as recommended by the National Strategy for Suicide
Prevention. The public health approach is widely regarded as the approach that is most likely to produce
significant and sustained reductions in suicide using a system of defining the problem, identifying causes,
and implementing and evaluating evidence-based prevention and early intervention strategies. As such,
the Oklahoma Strategy for Suicide Prevention is closely aligned with the goals outlined in the National
Strategy with objectives tailored to address the specific needs of Oklahomans.
The components identified in this state plan will be coordinated by the Oklahoma Suicide Prevention Council. This council will oversee the development of different stages of the state strategy over a five-year period through 2015, and provide assistance to communities in identifying which of the plan’s activities their community is ready for and how to implement them. Members of the council are legislatively appointed and represent various state agencies, survivors of suicide, legislators, and interested individuals. This state strategy will involve regular ongoing review and revision. This review will involve tracking progress and achievement of goals as well as annual reporting on progress to the state Legislature.
It is the purpose of the Oklahoma Strategy for Suicide Prevention to prevent suicide attempts, suicidal
behaviors, and suicide deaths across the lifespan through the achievement of the following goals:
1. Promote awareness that suicide is a public health problem that is preventable.
2. Develop broad-based support for suicide prevention.
3. Develop and implement strategies to reduce the stigma associated with being a consumer of mental
health, substance abuse and suicide prevention services.
4. Develop and implement community-based suicide prevention programs.
5. Promote efforts to reduce access to lethal means and methods of self-harm.
6. Develop and promote effective clinical and professional practices.
7. Increase access to and community linkages with mental health and substance abuse services.
8. Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the
entertainment and news media.
9. Promote and support research on suicide and suicide prevention.
10. Improve and expand suicide surveillance systems. 11. Provide support for survivors of suicide.
The Oklahoma Strategy is comprehensive and ambitious. To achieve these goals it will be necessary for
Oklahomans at the state and local levels to take action. The strategy calls upon schools, state agencies,
tribes, faith communities, media, health care providers, community coalitions, just to name a few, to
implement portions of the plan. Through continued collaboration and commitment to the strategy, lives
will be saved.| 5
THE PUBLIC HEALTH APPROACH IS WIDELY REGARDED AS THE APPROACH THAT IS MOST LIKELY TO PRODUCE SIGNIFICANT AND SUSTAINED REDUCTIONS IN SUICIDE6 |
RECOGNITION
INTERVENTION
IMPACT| 7
What Causes Suicide?
The causes of suicide are complex and vary among individuals and across age, cultural, racial, and ethnic groups. The risk of suicide is influenced by an array of biological, psychological, social, environmental, and cultural risk factors. • • •
Many people who attempted or completed suicide had one or more warning signs before their death.
While warning signs refer to more immediate signs or symptoms in an individual, risk factors for suicide
are generally longer-term factors that are associated with a higher prevalence of suicide in the population.
Recognition of warning signs has a greater potential for immediate prevention and intervention when
those who are in a position to help know how to appropriately respond.
Feelings of hopelessness and an inability to make positive changes in one’s life are two consistent
psychological precursors to suicidal behaviors. Many of those who die by suicide are described by family or
friends as having been depressed or as having problems with a current or former intimate partner.
Trauma has a significant impact on suicide risk across the life span. A survey of over 17,000 people
found that a history of adverse childhood experiences was associated with a significant increase in the
prevalence of attempted suicides. For example, individuals reporting that their parents had separated
or divorced were twice as likely to have attempted suicide, and those who were emotionally abused
as children were five times as likely to have attempted suicide. For each additional adverse experience,
the risk of attempted suicide increased by about 60 percent. This study also found a high prevalence of
depression and substance abuse, suggesting that a history of adverse childhood experiences is associated
with a host of negative outcomes.
Risk Factors for Suicide
BIOPSYCHOSOCIAL RISK FACTORS
• M ental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
• Alcohol and other substance use disorders
• Hopelessness
• Impulsive and/or aggressive tendencies
• History of trauma or abuse
• Some major physical illnesses
• Previous suicide attempt
• Family history of suicide
SCOPE OF THE PROBLEM8 |
ENVIRONMENTAL RISK FACTORS
• Job or financial loss
• Relational or social loss
• Easy access to lethal means
• Local clusters of suicide that have a contagious influence
SOCIAL/CULTURAL RISK FACTORS
• Lack of social support and sense of isolation
• Stigma associated with help-seeking behavior
• Barriers to accessing health care, especially mental health and substance abuse treatment
• Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution
to a personal dilemma)
• Exposure to, including through the media, and influence of others who have died by suicide
What Protects Against Suicide?
• • •
Protective factors can reduce the likelihood of suicide by counterbalancing some of the risk factors.
Examining populations with lower suicide rates can help understand potential protective factors and
focuses for prevention strategies. Social, political, and economic factors may help explain different rates of
suicide between countries and states. Differences in rates of depressive disorders, alcohol consumption,
proportion of older adults, levels of social isolation, and religiosity may all play a role in the rate of suicide.
In the United States, suicide rates among African American women, particularly in middle age, are very
low. Sociocultural differences between population groups and between individuals, including social connectedness, family relations, marital status, parenthood, and participation in religious activities and
beliefs (including negative moral attitudes toward suicide), may all be important underlying factors.
Protective Factors for Suicide
• Effective clinical care for mental, physical and substance use disorders
• Easy access to a variety of clinical interventions and support for helpseeking
• Restricted access to highly lethal means of suicide
• Strong connections to family and community support
• Support through ongoing medical and mental health care relationships
• Skills in problem solving, conflict resolution and nonviolent handling of disputes
• Cultural and religious beliefs that discourage suicide and support self-preservation| 9
Suicide in Oklahoma
• • •
Oklahoma is ranked 13th highest among all states for the number of suicide deaths per capita. Suicide was
the most prevalent type of violent death in Oklahoma from 2004 to 2007, accounting for 2,057 deaths
(14.4 suicides annually per 100,000 population), an average of 514 deaths per year. The rate of suicide was
stable from 2004 to 2007. In 52 of the suicide deaths, the victim killed at least one other person before
taking his/her own life, resulting in 65 homicide deaths.
TABLE 1.
Suicide by Year
Oklahoma, 2004-2007
Year Number Rate
2004 496 14.1
2005 517 14.6
2006 528 14.8
2007 516 14.3
SUICIDE WAS THE MOST PREVALENT TYPE OF VIOLENT DEATH IN OKLAHOMA FROM 2004-2007
* Per 100,000 population.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent
Death Reporting System, 2004-2007, Injury Prevention Service,
Oklahoma State Department of Health.10 |
TABLE 3.
Gender, Race, and Ethnicity Specific Rates of Suicide
Oklahoma, 2004-2007
■ Male ■ Female
Race/Ethnicity
0
5
10
15
20
25
30
Rate per 100,000 Population
White Native American Black Asian Hispanic Ethnicity
25.9
7.4
24
5.4
10.8
2 2.3 1.5
12.1
3.8
Age
The youngest person to die by suicide was 12
years of age and the oldest person was 96 years.
Seventy-eight percent of suicide victims were
male and 22 percent were female. Males 75-84
years of age had the highest suicide rate among all
ages. Among females, women 35-54 years were
at greatest risk for suicide. White males had the
highest suicide rate (25.9 percent), followed by
Native American males (24.0 percent), black males
(10.8 percent), and Asian males (2.3 percent).
TABLE 2.
Age and Gender Specific Rates of Suicide* Oklahoma, 2004-2007
■ Male ■ Female
0
10
20
30
40
50
60
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Rate per 100,000 Population
Age Group
1.1 0.4
20.1
4.8
26.8
7
34.3
10.5
32.8
12.2
24.4
8.9
26.9
4.5
47
5.2
45.4
1.7
* Includes 2,057 persons.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System,
2004-2007, Injury Prevention Service, Oklahoma State Department of Health.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System,
2004-2007, Injury Prevention Service, Oklahoma State Department of Health.| 11
TABLE 4. Suicide by Age, Gender, Race,* and Ethnicity**, Oklahoma, 2004-2007
White Black Native American Asian Hispanic
Age Number Rate Number Rate Number Rate Number Rate Number Rate
Both Genders
5-14 12 0.8 1 0.5 2 0.9 0 0.0 3 1.5
15-24 190 11.8 16 7.3 50 20.8 2 4.1 21 12.1
25-34 241 16.1 26 14.7 41 23.5 1 1.8 28 15.0
35-44 358 23.3 14 8.9 41 25.5 1 2.4 15 11.2
45-54 396 23.8 9 6.2 31 20.0 1 3.2 12 14.6
55-64 237 18.1 5 5.9 4 3.8 0 0.0 0 0.0
65-74 135 15.6 2 4.2 6 10.2 0 0.0 1 5.1
75-84 139 23.9 1 3.7 3 9.3 0 0.0 0 0.0
85+ 38 16.2 1 9.1 0 0.0 0 0.0 0 0.0
Total 1,746 15.2 75 6.2 178 14.0 5 1.8 80 8.3
Males
5-14 10 1.5 1 0.9 0 0.0 0 0.0 2 2.0
15-24 153 20.3 12 10.7 43 36.5 2 7.9 17 17.7
25-34 193 29.1 22 25.5 30 36.2 1 3.5 22 20.5
35-44 272 38.5 11 14.8 34 44.5 0 0.0 12 16.3
45-54 282 36.2 9 13.2 25 34.8 0 0.0 9 20.0
55-64 170 27.8 4 10.3 3 6.1 0 0.0 0 0.0
65-74 111 28.4 2 9.9 6 23.0 0 0.0 1 10.6
75-84 120 51.1 1 9.9 3 22.9 0 0.0 0 0.0
85+ 35 49.2 1 30.1 0 0.0 0 0.0 0 0.0
Total Males 1,346 25.9 63 10.8 144 24.0 3 2.3 63 12.1
Females
5-14 2 0.3 0 0.0 2 1.9 0 0.0 1 1.0
15-24 37 5.3 4 4.0 7 6.2 0 0.0 4 5.2
25-34 48 7.3 4 4.8 11 13.1 0 0.0 6 7.5
35-44 86 12.1 3 3.8 7 8.8 1 4.8 3 5.0
45-54 114 14.1 0 0.0 6 7.6 1 5.7 3 8.0
55-64 67 10.2 1 2.2 1 1.8 0 0.0 0 0.0
65-74 24 5.3 0 0.0 0 0.0 0 0.0 0 0.0
75-84 19 5.6 0 0.0 0 0.0 0 0.0 0 0.0
85+ 3 1.9 0 0.0 0 0.0 0 0.0 0 0.0
Total Females 400 7.4 12 2.0 34 5.4 2 1.5 17 3.8
* Race was “mixed” for 2 persons, “other” for 44 persons, and unknown for 7 persons.
** Hispanic ethnicity is counted separately from race and is not a racial category. Hispanic ethnicity was unknown for 17 persons.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.12 |
Suicide Method/Mean
Firearms were used in 59 percent of the suicide deaths, hanging/strangulation
in 19 percent, poisoning in 17 percent, and other methods were used in 5
percent of suicides. Other methods used to complete suicide were sharp/blunt
instrument (30), motor vehicle or other transportation vehicle (27), drowning
(16), fire (16), fall (7), and unknown (2) methods. Firearms were used in male
suicide deaths more often than in female suicide deaths, 66 percent and 40
percent, respectively. Poisoning was used more often in female suicide than
male suicide, 38 percent and 11 percent, respectively.
Circumstances
A substantial number of suicides were associated with a current depressed
mood, intimate partner problem, mental health problem, physical health
problem, and/or crisis in the past two weeks. Circumstances associated with
suicide varied by age. Physical health problems were more often associated
with suicide among persons 65 years and older. Intimate partner problems
were more often associated with suicides of persons less than 65 years of age.
Almost one in five suicide victims had a history of suicide attempts. Thirty
percent had stated their intent or expressed suicidal feeling to another person
and 29 percent left a suicide note.
Seventy-six percent of persons who died by suicide with a current mental
health problem were receiving mental health treatment, including 65 percent
of persons 12-24 years, 77 percent of persons 25-44 years, 80 percent of
persons 45-64 years, and 65 percent of persons 65 years and older.
FIGURE 1.
Method of Suicide by Gender Oklahoma, 2004-2007
Firearm
66%
Hanging/
Strangulation
19%
Poisoning
11%
Sharp/Blunt
Instrument
1% Other
3%
Sharp/Blunt
Instrument
1% Other
5%
Firearm
39%
Hanging/
Strangulation
17%
Poisoning
38%
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent
Death Reporting System, 2004-2007, Injury Prevention Service,
Oklahoma State Department of Health.
Male
Female| 13
TABLE 5. Selected Suicide Circumstances by Gender, Oklahoma, 2004-2007*
Total (n=2,057) Male (n=1,599) Female (n=458)
Number Percent Number Percent Number Percent
Current depressed mood 941 46 731 46 210 46
Intimate partner problem 682 33 551 34 131 29
Disclosed intent to commit suicide 614 30 463 29 151 33
Mental health problem 583 28 396 25 187 41
Depression/dysthymia 281 14 209 13 72 16
Bipolar disorder 76 4 34 2 42 9
Schizophrenia 35 2 26 2 9 2
Anxiety disorder 26 1 16 1 10 2
Post-traumatic stress disorder 5 0 4 0 1 0
Obsessive-compulsive disorder 2 0 2 0 0 0
Eating disorder 1 0 0 0 1 0
Other/unknown 217 11 136 9 81 18
Left a suicide note 601 29 458 29 143 31
Physical health problem 559 27 431 27 128 28
Crisis in past two weeks 505 25 413 26 92 20
History of previous suicide attempts 367 18 223 14 144 31
Substance abuse 278 14 194 12 84 18
Financial problem 241 12 188 12 53 12
Other relationship problem 222 11 161 10 61 13
Alcohol 188 9 155 10 33 7
Job problem 187 9 162 10 25 5
Recent criminal legal problem 179 9 160 10 19 4
Other death of friend or family 139 7 112 7 27 6
Non-criminal legal problem 85 4 70 4 15 3
Perpetrator of interpersonal violence within past month 49 2 44 3 5 1
Suicide of friend or family within past five years 34 2 20 1 14 3
School problem 14 1 11 1 3 1
Victim of interpersonal violence within past month 7 0 3 0 4 1
* More than one circumstance may have been associated with the death. Percentages were calculated using the total number of persons that committed suicide.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.14 |
TABLE 6. Ten Most Common Circumstances* Associated with Suicide Deaths by Rank and Age Group, Oklahoma, 2004-2007*
Rank
1
2
3
4
5
6
7
8
9
10
12-24 Years
Current depressed mood (41%)
Intimate partner
problem (38%)
Crisis in past 2 weeks
(30%)
Current mental health
problem (22%)
Relationship problem
other than intimate
partner (21%)
Substance abuse
problem (19%)
History of suicide
attempts (19%)
Recent criminal/legal problem (9%)
Job problem (8%)
Financial problem (6%)
25-44 Years
Intimate partner
problem (47%)
Current depressed mood (43%)
Current mental health
problem (31%)
Crisis in past 2 weeks
(28%)
History of suicide
attempts (21%)
Substance abuse
problem (19%)
Recent criminal/legal problem (13%)
Financial problem (12%)
Physical health
problem (12%)
Alcohol problem
(12%)
45-64 Years
Current depressed mood (49%)
Current mental health
problem (31%)
Physical health
problem (31%)
Intimate partner
problem (29%)
Crisis in past 2 weeks
(21%)
History of suicide
attempts (20%)
Financial problem (16%)
Job problem (13%)
Substance abuse
problem (11%)
Alcohol problem (11%)
65+ Years
Physical health
problem (73%)
Current depressed mood (49%)
Crisis in past 2 weeks
(21%)
Current mental health
problem (20%)
Death of family or
friend (13%)
History of suicide
attempts (8%)
Intimate partner
problem (7%)
Financial Problem (6%)
Other relationship
problem (5%)
Alcohol problem (3%)
*More than one circumstance may have been associated with the suicide.
TABLE 11. Suicide Deaths of Veterans by Age, Oklahoma, 2004-2007
Age Number Percent
15-24 18 4%
25-34 30 6%
35-44 53 11%
45-54 77 17%
55-64 90 19%
65+ 198 42%
Total 466 100%
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.| 15
FIGURE 2.
Suicide Death Rates by County of Residence Oklahoma, 2004-2007
Circumstances (Continued)
A positive blood alcohol test was documented for 570 persons (30 percent of
persons tested), and a positive drug test was documented for 393 persons (88
percent of persons tested) who died by suicide.
Twenty-three percent (466) of suicide victims were veterans (persons who had served in the U.S. Armed Forces), including 456 males and 10 females. This represents 76 percent (466/615) of all violent deaths among veterans. The mean age of veterans who committed suicide was 59 years. The youngest victim was 18 and the oldest was 93 years of age; 42 percent of these suicide deaths were among veterans 65 years of age and older. The vast majority (78 percent) of suicides among veterans were completed with a firearm. Other methods of suicide among veterans were poisoning (11 percent), hanging/strangulation (8 percent), and other methods (3 percent). The circumstances most often associated with the veteran suicide were current depressed mood (49 percent), physical health problem (52 percent), crisis in the past two weeks (25 percent), current mental health problem (24 percent), and intimate partner problem (24 percent).
Forty counties had suicide rates higher than the state rate, 36 counties had
suicide rates below the state rate, and in one county there were no suicide
deaths during 2004-2007.
Ideation
The percentage of Oklahoma students who felt
sad and hopeless almost every day for two weeks
or more in a row was down in 2007 compared
to 2003 and 2005. Overall, about one-fourth of
students felt sad or hopeless almost every day for
two or more weeks in a row. Tenth grade females
reported the highest percentage of feeling sad or
hopeless almost every day for two or more weeks
in a row. Ninth grade females reported the highest
percentage of students who seriously considered
suicide. Overall, over one in 10 students reported
they had seriously considered suicide.
Economic Costs
The average medical cost per incident of
hospitalized suicide attempt in 2006 was $7,995,
and the average work loss per case of hospitalized
suicide attempt was $9,213. For suicide deaths, the
average medical cost per incident was $3,908. The
average work loss per case of suicide death was
$1.08 million.
■ 50+% Above State Rate
■ 25-49% Above State Rate
■ 1-24% Above State Rate
■ Below State Rate
■ No Deaths
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.16 |
STRATEGY
GOALS
PREVENTION| 17
Goal 1
Promote awareness that suicide is a public health problem that is preventable. • • •
Rationale:
The stronger and broader the support for a public health initiative, the greater its chance for success. If
the general public understands that suicide and suicidal behaviors can be prevented, and people are made
aware of the roles individuals and groups can play in prevention, the suicide rate can be reduced.
Objectives for Action:
OBJECTIVE 1.1 Implement a minimum of one public information campaign, designed to increase public knowledge of suicide prevention, in all 77 counties of Oklahoma.
OBJECTIVE 1.2 The state suicide prevention council will foster collaboration with stakeholders
on prevention strategies across disciplines and with the public.
OBJECTIVES FOR ACTION
SUICIDE IS A PUBLIC HEALTH PROBLEM THAT IS PREVENTABLEGoal 2:
Develop broad-based support for suicide prevention. • • •
Rationale:
Collaboration across a broad spectrum of agencies, institutions, and groups is a way to ensure that
prevention efforts are comprehensive. Such collaboration can also generate greater and more effective
attention to suicide prevention than can these groups working alone. Broad-based support for suicide
prevention may also lead to additional funding and to the incorporation of suicide prevention activities
into organizations that have not previously addressed it.
Objectives for Action:
OBJECTIVE 2.1 Sustain funding for an Office of Suicide Prevention within the Department
of Mental Health and Substance Abuse Services to serve as an ongoing,
centralized coordination of suicide prevention activities across the state.
OBJECTIVE 2.2 Ensure that existing Oklahoma community coalitions have information about
suicide, prevention strategies and training opportunities.
OBJECTIVE 2.3 Ensure that state agencies have information about suicide, prevention
strategies and training opportunities.
OBJECTIVE 2.4 Ensure that institutes of higher learning have information about suicide,
prevention strategies and training opportunities.| 19
Goal 3:
Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services.
• • •
Rationale:
Suicide is closely linked to mental illness and to substance abuse; and effective treatments exist for
both. However, the stigma of mental illness and substance abuse prevents many persons from seeking
assistance. The stigma of suicide itself–the view that suicide is shameful and/or sinful–is also a barrier to
treatment for persons who have suicidal thoughts or who have attempted suicide. Family members of
suicide attempters often hide the behavior from friends and relatives, and those who have survived the
suicide of a loved one suffer not only the grief of loss, but often the added pain stemming from stigma.
Stigma associated with mental illness, substance abuse, and suicide has resulted in the establishment of
separate systems for physical and mental health care. One consequence is that preventive services and
treatment for mental illness and substance abuse are much less available than for other health problems.
Destigmatizing mental illness, substance use disorders and suicide could increase access to treatment by
integrating care and increasing the willingness of individuals to seek treatment.
Objectives for Action:
OBJECTIVE 3.1 Increase the proportion of the public that views mental and physical health as
equal, inseparable components of overall health.
OBJECTIVE 3.2 Increase the proportion of Oklahomans with suicidal ideations or related conditions who seek mental health treatment services by promoting and increasing the capacity of Oklahoma’s center for the National Suicide Prevention Lifeline and referrals to services.
THE STIGMA OF MENTAL ILLNESS AND SUBSTANCE ABUSE PREVENTS MANY PERSONS FROM SEEKING ASSISTANCE20 |
EFFECTIVE SUICIDE PREVENTION PROGRAMS REQUIRE COMMITMENT AND RESOURCES
Goal 4:
Develop and implement community-based suicide prevention programs. • • •
Rationale:
Research has shown that many suicides are preventable; however, effective suicide prevention programs
require commitment and resources. Effective prevention strategies may include:
• Training for key gatekeepers (people who regularly come into contact with individuals or families in
distress) to recognize risk factors and intervene;
• S creening for suicide risk; and/or
• Promotion of coping and other life skills that develop help-seeking behavior and resilience.
The objectives established for this goal are designed to foster planning and program development work
and to ensure the integration of evidence-based suicide prevention within key organizations and sectors of
the community that have access to groups of individuals who otherwise might not receive the information. Objectives for Action:
OBJECTIVE 4.1 Increase the proportion of counties in Oklahoma with comprehensive
suicide prevention plans. All 77 counties should have a plan in place.
OBJECTIVE 4.2 Increase the proportion of school districts, private school associations, and
tribal schools, with evidence-based strategies designed to address serious
childhood and adolescent distress to prevent suicide.
OBJECTIVE 4.3 Increase the proportion of colleges and universities with evidence-based strategies designed to address serious young adult distress to prevent suicide.
OBJECTIVE 4.4 Increase the proportion of employers that ensure the availability of
evidence-based prevention strategies for suicide.
OBJECTIVE 4.5 Increase the proportion of correctional institutions, jails and detention
centers housing either adult or juvenile offenders, with evidence-based
suicide prevention strategies.
OBJECTIVE 4.6 Increase the proportion of state aging networks that have evidence-based
suicide prevention strategies designed to identify and refer for treatment
elderly people at risk for suicidal behavior.
OBJECTIVE 4.7 Increase the proportion of family, youth and community service providers
and organizations with evidence-based suicide prevention strategies.
OBJECTIVE 4.8 Increase the proportion of faith based organizations with evidence-based
suicide prevention strategies.
OBJECTIVE 4.9 Increase the proportion of primary health care organizations and providers
with evidence-based suicide prevention strategies.
OBJECTIVE 4.10 Increase the proportion of tribes with evidence-based suicide prevention
strategies.
OBJECTIVE 4.11 Increase the proportion of counties (or comparable jurisdictions such as
cities or tribes) in which education programs are available to family members
and others in close relationships with those at risk for suicide.22 |
Goal 5:
Promote efforts to reduce access to lethal means and methods of self-harm.
• • •
Rationale:
Evidence shows that limiting access to lethal means of self-harm may be an effective strategy to prevent
self-destructive behaviors. Often referred to as “means restriction,” this approach is based on the
belief that a small, but significant minority of suicidal acts are, in fact, impulsive and of the moment;
they result from a combination of psychological pain or despair coupled with the easy availability of
the means by which to inflict self-injury. Thus, a self-destructive act may be prevented by limiting the
individual’s access to the means of self-harm. Evidence suggests that there may be a limited time effect
for decreasing self-destructive behaviors in susceptible and impulsive individuals when access to the
means for self-harm is restricted. The objectives established for this goal are designed to separate the
suicidal impulse from access to lethal means of self-harm.
Objectives for Action:
OBJECTIVE 5.1 Increase the proportion of primary care clinicians, other health care
providers, and health and safety officials who routinely assess the presence
of lethal means (including firearms, drugs, and poisons) in the home and
educate about actions to reduce associated risks.
OBJECTIVE 5.2 Initiate a targeted public awareness campaign for guns and medications
safety to expose a larger proportion of households designated to reduce the
accessibility of lethal means, including firearms and medications, in the home.
OBJECTIVE 5.3 Initiate a gun lock or exchange your lock program in partnership with other
state agencies.
OBJECTIVE 5.4 Develop guidelines for safer dispensing of medications for individuals at
heightened risk of suicide.| 23
A SELF-DESTRUCTIVE ACT MAY BE PREVENTED BY LIMITING THE INDIVIDUAL’S ACCESS TO THE MEANS OF SELF-HARM24 |
Goal 6:
Develop and promote effective clinical and professional practices.
• • •
Rationale:
One way to prevent suicide is to identify individuals at risk and to engage them in treatments that are
effective in reducing the personal and situational factors associated with suicidal behaviors (e.g., depressed
mood, hopelessness, helplessness, alcohol and other drug abuse, etc.). Another way to prevent suicide
is to promote and support the presence of protective factors, such as learning skills in problem solving,
conflict resolution, and nonviolent handling of disputes. By improving clinical practices in the assessment,
management, and treatment of individuals at risk for suicide, the chances for preventing those individuals
from acting on their despair and distress in self-destructive ways are greatly improved. Moreover,
promoting the presence of protective factors for these individuals can contribute importantly to reducing
their risk. The objectives established for this goal are designed to heighten awareness of the presence
or absence of risk and protective conditions associated with suicide, leading to better triage systems and
better allocation of resources for those in need of specialized treatment.
ONE WAY TO PREVENT SUICIDE IS TO IDENTIFY INDIVIDUALS AT RISK AND TO ENGAGE THEM IN TREATMENTS THAT ARE EFFECTIVEObjectives for Action:
OBJECTIVE 6.1 Promote guidelines for assessment of suicide risk among persons receiving care in primary health care
settings, emergency departments, and specialty mental health and substance abuse treatment centers.
OBJECTIVE 6.2 Increase the proportion of specialty mental health and substance abuse treatment centers that have
policies, procedures, and training for all staff designed to assess suicide risk and intervene to reduce
suicidal behaviors among their patients.
OBJECTIVE 6.3 Encourage aftercare treatment and referrals for individuals exhibiting suicidal behavior and ideation (including those discharged from inpatient facilities and hospitals).
OBJECTIVE 6.4 Train those who provide key services to suicide survivors (e.g., emergency medical technicians,
firefighters, law enforcement officers, funeral directors, clergy, medical examiners) to addresses their
own (the service provider) exposure to suicide in addition to the unique needs of suicide survivors.
OBJECTIVE 6.5 Develop and disseminate informational materials to individuals and agencies that routinely provide immediate post-trauma psychological support and mental health education for all victims of sexual
assault and/or physical abuse (e.g., law enforcement, hospital emergency departments, crisis
intervention works, sexual assault nurse examiners, emergency shelter workers, etc).
OBJECTIVE 6.6 Develop and disseminate information and materials providing education to family members and
significant others of persons receiving care who may be at risk of suicide. Implement the guidelines
in facilities (including those in general and psychiatric hospitals, community mental health clinics, and
substance abuse treatment facilities).
OBJECTIVE 6.7 Promote screening for depression, substance abuse and suicide risk as a minimum standard of care for
assessment in primary care settings, hospice, and skilled nursing facilities.
OBJECTIVE 6.8 Increase the number of recertification or licensing programs in relevant professions that require or
promote competencies in depression assessment and management and suicide prevention.
OBJECTIVE 6.9 A legislative mandate shall be in place requiring all professional licensing agencies to require continuing
education on suicide prevention each year for licensure.
OBJECTIVE 6.10 Oklahoma shall have at least two certified suicide prevention trainers in each county at all times, the
number required will be proportionate to the population size.
OBJECTIVE 6.11 Oklahoma shall have a 24/7 aftercare and postvention team of personnel created and trained regionally to:
• Provide support after a death by suicide.
• Prevent additional deaths among survivors and the immediate community.
• Collect information regarding the proceeding circumstances to inform future suicide
prevention practices.26 |
Goal 7:
Increase access to and community linkages with mental health and substance abuse services.
• • •
Rationale:
Barriers to equal access and affordability of health care may be influenced by financial, structural, and personal factors. Financial barriers include not having enough health insurance or not having the financial capacity to pay for services outside a health plan or insurance program. Structural barriers include the lack of primary care providers, medical specialists or other health care professionals to meet special needs or the lack of health care facilities. Personal barriers include cultural or spiritual differences, language, not knowing when or how to seek care, or concerns about confidentiality or discrimination. Reducing disparities is a necessary step in ensuring that all Americans receive appropriate physical health, mental health, and substance abuse services. One aspect of improving access is to better coordinate the services of a variety of community institutions. This will help ensure that at-risk populations receive the services they need, and that all community members receive regular preventive health services. The objectives established for this goal are designed to enhance inter-organizational communication to facilitate the provision of health services to those in need of them.
Objectives for Action:
OBJECTIVE 7.1 Develop and disseminate guidelines for schools on appropriate linkages with
mental health and substance abuse treatment services and implement those
guidelines in a proportion of school districts.
OBJECTIVE 7.2 Increase the number of school districts that have a formalized relationship
with mental health and substance abuse providers.
OBJECTIVE 7.3 Increase the number of mental health courts to one in every county in
Oklahoma.
OBJECTIVE 7.4 Increase the proportion of counties (or comparable jurisdictions) in
which the guidelines for effective suicide survivor support programs are
implemented.
OBJECTIVE 7.5 Increase the proportion of counties (or comparable jurisdictions) with
health and/or social services outreach programs for at-risk populations that
incorporate mental health services and suicide prevention.
OBJECTIVE 7.6 Identify strategic locations and information to link people to services and
offer referrals for crisis interventions.
OBJECTIVE 7.7 Develop an active survivor of suicide support group in every county.| 27
Goal 8:
Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the entertainment and news media.
• • •
Rationale:
The media can have a powerful impact on perceptions of reality and behavior. Research over many
years has found that media representations of suicide may increase suicide rates, especially among youth.
“Cluster suicides” and “suicide contagion” have been documented, and studies have shown that both news
reports and fictional accounts of suicide can lead to increases in suicide. On the other hand, it is widely
acknowledged that the media can play a positive role in suicide prevention. The way suicide is presented is
particularly important. Media portrayals of mental illness and substance abuse may also affect the suicide
rate. Negative views of these problems may lead individuals to deny they have a problem or be reluctant
to seek treatment—and untreated mental illness and substance abuse are strongly correlated with suicide.
The objectives established for this goal are designed to foster consideration among media leaders of the
impact of different styles of describing or otherwise depicting suicide and suicidal behavior, mental illness,
and substance abuse, and to encourage media representations of suicide that can help prevent rather than
increase suicide.
Objectives for Action:
OBJECTIVE 8.1 Increase the number of journalism schools that include in their curricula
guidance on the appropriate portrayal and reporting of mental illness, suicide
and suicidal behaviors.
OBJECTIVE 8.2 Increase the proportion of Oklahoma media outlets that actively participate
in promoting accurate and responsible depiction of suicidal behavior, mental
illness and related issues.
OBJECTIVE 8.3 Increase the number of Oklahoma media outlets that are following and have
available the national guidelines for responsible reporting of deaths by suicide.
THE MEDIA CAN HAVE A POWERFUL IMPACT ON PERCEPTIONS OF REALITY AND ON BEHAVIOR28 |
THE VOLUME OF RESEARCH ON SUICIDE AND ITS RISK FACTORS HAS INCREASED CONSIDERABLY IN THE PAST DECADE AND HAS GENERATED NEW QUESTIONS| 29
Goal 9:
Promote and support research on suicide and suicide prevention.
• • •
Rationale:
The volume of research on suicide and its risk factors has increased considerably in the past
decade and has generated new questions about why individuals become suicidal or remain suicidal.
Important contributions of underlying mental illness, substance abuse, and biological factors, as well
as potential risk that comes from certain environmental influences are becoming clearer. Increasing
the understanding of how individual and environmental risk and protective factors interact with each other to affect an individual’s risk for suicidal behavior is the next challenge. This understanding can
contribute to the limited but growing information about how modifying risk and protective factors
changes outcomes pertaining to suicidal behavior.
The objectives established for this goal are designed to support a wide range of research endeavors
focused on the etiology, expression, and maintenance of suicidal behaviors across the lifespan. The
enhanced understanding to be derived from this research will lead to better assessment tools,
treatments, and preventive interventions.
Objectives for Action:
OBJECTIVE 9.1 Develop an Oklahoma suicide research agenda with input from survivors,
practitioners, researchers, and advocates.
OBJECTIVE 9.2 Establish funding (public and private) for suicide prevention research, for
research on translating scientific knowledge into practice, and for training of
researchers in suicidology.
OBJECTIVE 9.3 Require Oklahoma suicide prevention efforts to include research-based
prevention activities that have demonstrated effectiveness for suicide or
suicide behaviors.
OBJECTIVE 9.4 Conduct at least one scientific evaluation study on new or existing suicide
prevention interventions.
OBJECTIVE 9.5 Develop and measure the effectiveness of suicide prevention efforts in
high-risk populations (e.g., older adults; veterans; rural Oklahomans; non-
Hispanic White or Native American race; males; those in prison/jail; persons
who are gay, lesbian, bisexual, transgender; persons who have experienced
post-emergency situations.).
OBJECTIVE 9.6 Conduct five cultural analyses, pilot studies, and/or qualitative studies to
better understand the cultural scripts/processes for suicide and suicide
prevention in Oklahoma’s various cultural groups and populations.30 |
Goal 10:
Improve and expand suicide surveillance systems.
• • •
Rationale:
Surveillance has been defined as the systematic and ongoing collection of data. Surveillance systems
are key to health planning. They are used to track trends in rates, to identify new problems, to provide
evidence to support activities and initiatives, to identify risk and protective factors, to target high risk
populations for interventions, and to assess the impact of prevention efforts. Accurate data on suicide
and suicidal behavior are needed at the State and local levels. State and local data help establish local
program priorities and are necessary for evaluating the impact of suicide prevention strategies. The
objectives established for this goal are designed to enhance the quality and quantity of data available on
suicide and suicidal behaviors and ensure that the data are useful for prevention purposes.
Objectives for Action:
OBJECTIVE 10.1 Refine standardized protocols for death scene investigations and implement
these protocols in the 10 Oklahoma counties with the highest suicide rates.
OBJECTIVE 10.2 Increase the number of psychological autopsy investigations on completed
suicides.
OBJECTIVE 10.3 Obtain 100 percent participation of hospitals (including emergency
departments) that collect uniform and reliable data on suicidal behavior by
accurately coding external cause of injuries, utilizing the categories included
in the International Classification of Diseases.
OBJECTIVE 10.4 Maintain participation in the National Violent Death Reporting System that
includes suicides and collects information not currently available from death
certificates (i.e., psychological autopsies).
OBJECTIVE 10.5 Increase the number of jurisdictions that produce annual reports on
suicide and suicide attempts, integrating data from multiple Oklahoma data
management systems.
OBJECTIVE 10.6 Explore mandating reports on suicide attempts to the Oklahoma State
Department of Health.
OBJECTIVE 10.7 Increase the number of surveys (e.g., across the lifespan, rural/urban/tribal
areas, college students, emergency department patients, primary care
patients, Veterans) that include questions on suicidal behavior.
Objective 10.8: Develop user-friendly web site to distribute data to appropriate parties and
professionals.| 31
Goal 11:
Provide support for survivors of suicide.
• • •
Rationale:
Every year about 500 Oklahomans of all ages die by suicide. Each of these tragic deaths immediately
affects five to eight close relatives. Friends and co-workers are also profoundly affected by each of these
losses. Support to the survivors decreases the risk of the contagion effects of suicide or cluster events.
Objectives for Action:
OBJECTIVE 11.1 Promote and support a network of support groups across the state.
OBJECTIVE 11.2 Promote and support basic guidelines, curriculum and training as
recommended by the American Foundation for Suicide Prevention.
EVERY YEAR ABOUT 500 OKLAHOMANS OF ALL AGES DIE BY SUICIDE.32 |
Contagion
A phenomenon whereby susceptible persons
are influenced towards suicidal behavior through
knowledge of another person’s suicidal acts
Gatekeeper
Individuals trained to identify persons at risk of
suicide and refer them to treatment or supporting
services as appropriate
Ideation
Thoughts of engaging in suicide-related behavior
Means
The instrument or object whereby a self-
destructive act is carried out (i.e., firearm, poison,
medication)
Postvention
A strategy or approach that is implemented after a
crisis or traumatic event has occurred
Prevention
A strategy or approach that reduces the likelihood
of risk of onset, or delays the onset of adverse
health problems or reduces the harm resulting
from conditions or behaviors
Protective factors
Factors that make it less likely that individuals
will develop a disorder; protective factors may
encompass biological, psychological or social factors in the individual, family and environment
Risk factors
Factors that make it more likely that individuals will
develop a disorder; risk factors may encompass
biological, psychological or social factors in the
individual, family and environment
Screening
Administration of an assessment tool to identify
persons in need of more in-depth evaluation or
treatment
Suicide
Death from injury, poisoning, or suffocation where
there is evidence that a self-inflicted act led to the
person’s death
Suicide attempt
A potentially self-injurious behavior with a nonfatal
outcome, for which there is evidence that the
person intended to kill himself or herself; a suicide
attempt may or may not result in injuries
Survivor
Family members, significant others, or
acquaintances who have experienced the loss of
a loved one due to suicide; sometimes this term is
also used to mean suicide attempt survivors
GLOSSARY OF FREQUENTLY USED TERMSOKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
www.ok.gov/odmhsas/Prevention_Programs/
OKLAHOMA STATE DEPARTMENT OF HEALTH (OSDH) www.ok.gov/health/ NATIONAL SUICIDE PREVENTION LIFELINE www.suicidepreventionlifeline.org/
NATIONAL SUICIDE PREVENTION LIFELINE - VETERANS www.suicidepreventionlifeline.org/Veterans/
SAVE | SUICIDE AWARENESS VOICES OF EDUCATION www.save.org/
AMERICAN ASSOCIATION OF SUICIDOLOGY
www.suicidology.org/ AMERICAN FOUNDATION FOR SUICIDE PREVENTION
www.afsp.org/ SUICIDE PREVENTION RESOURCE CENTER (SPRC) www.sprc.org/
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) mentalhealth.samhsa.gov/suicideprevention/ NIMH | NATIONAL INSTITUTE FOR MENTAL HEALTH
www.nimh.nih.gov
CDC | CENTERS FOR DISEASE CONTROL AND PREVENTION www.cdc.gov/violenceprevention/suicide/ WHO | WORLD HEALTH ORGANIZATION
www.who.int/topics/suicide/
UNITED STATES DEPARTMENT OF VETERANS AFFAIRS
OFFICE OF MENTAL HEALTH SERVICES (OMHS) www.mentalhealth.va.gov/suicide_prevention/
SUICIDE.ORG
SPAN USA | SUICIDE PREVENTION ACTION NETWORK USA www.spanusa.org/
ARMY G-1 SUICIDE PREVENTION www.preventsuicide.army.mil/
NAVY SUICIDE PREVENTION
www.suicide.navy.mil/ RESOURCESOKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
www.ok.gov/odmhsas/
This publication was printed by University Printing Services for the Oklahoma Department of Mental Health and Substance Abuse Services and developed [in part] with funding from grant number SM-57394, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). 300 copies of the publication were produced at a cost of $2623.00. No state appropriated funds were utilized for printing or production. The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. Copies of the publication have been deposited with the Oklahoma Department of Libraries, Publication’s Clearinghouse. (03/2011)

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OKLAHOMA STRATEGY FOR SUICIDE
PREVENTION
2011 Based on recommendations of the Oklahoma Suicide Prevention CouncilTHE OKLAHOMA STRATEGY FOR SUICIDE PREVENTION is dedicated to all Oklahomans who have experienced the tragedy of suicide and to the brave survivors.
The Oklahoma Suicide Prevention Council also dedicates this plan to the memory of Carol King, suicide survivor and advocate for suicide prevention in Oklahoma.
• • •| 1
Many individuals have dedicated time and energy to the development of the Oklahoma Strategy for Suicide Prevention. The Oklahoma Suicide Prevention Council acknowledges the following member and participating organizations for their commitment and support.
• • •
Aging Network
HeartLine
Indian Health Services
Long Term Care Authority
Minco Public Schools
Muscogee Creek Nation-Children’s Mental Health Initiative
Oklahoma Commission on Children and Youth
Oklahoma Department of Mental Health and Substance Abuse Services
Oklahoma Department of Veterans Affairs
Oklahoma Faith Communities
Oklahoma Mental Health and Aging Coalition
Oklahoma Office of Juvenile Affairs
Oklahoma State Department of Education
Oklahoma State Department of Health
Minco Public Schools
Survivors of Suicide
Tulsa Public Schools
University of Oklahoma
Youth Services for Oklahoma County
Youth Services of Tulsa
The Oklahoma Strategy for Suicide Prevention is purposefully and closely aligned with recommendations
of the National Strategy for Suicide Prevention, therefore the developers of this plan would like to
acknowledge the use of the National Strategy text throughout the document.
ACKNOWLEDGEMENTS2 |
COLLABORATION EFFORT
RESILIENCE | 3
Background
Resilience, strong will, collaboration, and effort are part of the fabric of our s tate’s history and citizenry. These characteristics were the driving force when a group of concerned Oklahomans first began gathering in 1997 to discuss the urgency and need to address the prevention of suicide. • • •
In 2001, the U.S. Department of Health and Human Services released the National Strategy for Suicide
Prevention, a comprehensive and integrated approach to reducing suicide and suicidal behaviors across
the life span. The national strategy is a culmination of efforts including the 1999 Surgeon General’s Call to
Action to Prevent Suicide and the landmark Mental Health: A Report of the Surgeon General (1999).
During the same time, a state plan to prevent youth suicide in Oklahoma was developed at the direction
of the Oklahoma Legislature. The plan was developed by a state task force created in 1999 by House
Joint Resolution No. 1018. Representatives from the task force presented on the development of
the Oklahoma plan at a public hearing in Atlanta, Georgia in 2000. The State Plan on Youth Suicide
Prevention was adopted in 2001 and the Oklahoma Youth Suicide Prevention Act was enacted, tasking a
new Youth Suicide Prevention Council to implement the plan.
Since 2001, the Oklahoma Youth Suicide Prevention Council has actively pursued opportunities to act
on the recommendations included in the state plan. The Council, comprised of suicide survivors, youth,
educators, mental health professionals, and state agencies, achieved two significant outcomes to advance
suicide prevention in the state. The first was making suicide a reportable injury so that hospitals reported
suicide attempts, greatly enhancing the state’s understanding of the scope of the problem. The second
major achievement was the state’s award of funds for youth suicide prevention and early intervention.
The Oklahoma Department of Mental Health and Substance Abuse Services was awarded federal
Garrett Lee Smith Youth Suicide Prevention and Early Intervention grant funding from the Substance
Abuse and Mental Health Services Administration for years 2005 to 2008, and then re-funded in 2008
through 2011. This funding allowed the state to begin implementation of several recommendations in the
state’s 2001 state suicide prevention plan, including statewide and community-based suicide prevention
training, suicide screening for youth and improved referral networks for youth at risk for suicide.
In 2008, the Council achieved another significant milestone when the Oklahoma Youth Suicide Prevention Act was amended by Senate Bill 2000 to become simply the Oklahoma Suicide Prevention Act, broadening the scope of the Council and the state plan to prevent suicide among Oklahomans of all ages. The Council and state Legislature recognized the need for a comprehensive strategy for Oklahoma citizens.
INTRODUCTION4 |
Purpose of Oklahoma’s Suicide Prevention Strategy
• • •
The Oklahoma Suicide Prevention Council recognizes suicide as a public health problem and proposes
strategies based on public health methods as recommended by the National Strategy for Suicide
Prevention. The public health approach is widely regarded as the approach that is most likely to produce
significant and sustained reductions in suicide using a system of defining the problem, identifying causes,
and implementing and evaluating evidence-based prevention and early intervention strategies. As such,
the Oklahoma Strategy for Suicide Prevention is closely aligned with the goals outlined in the National
Strategy with objectives tailored to address the specific needs of Oklahomans.
The components identified in this state plan will be coordinated by the Oklahoma Suicide Prevention Council. This council will oversee the development of different stages of the state strategy over a five-year period through 2015, and provide assistance to communities in identifying which of the plan’s activities their community is ready for and how to implement them. Members of the council are legislatively appointed and represent various state agencies, survivors of suicide, legislators, and interested individuals. This state strategy will involve regular ongoing review and revision. This review will involve tracking progress and achievement of goals as well as annual reporting on progress to the state Legislature.
It is the purpose of the Oklahoma Strategy for Suicide Prevention to prevent suicide attempts, suicidal
behaviors, and suicide deaths across the lifespan through the achievement of the following goals:
1. Promote awareness that suicide is a public health problem that is preventable.
2. Develop broad-based support for suicide prevention.
3. Develop and implement strategies to reduce the stigma associated with being a consumer of mental
health, substance abuse and suicide prevention services.
4. Develop and implement community-based suicide prevention programs.
5. Promote efforts to reduce access to lethal means and methods of self-harm.
6. Develop and promote effective clinical and professional practices.
7. Increase access to and community linkages with mental health and substance abuse services.
8. Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the
entertainment and news media.
9. Promote and support research on suicide and suicide prevention.
10. Improve and expand suicide surveillance systems. 11. Provide support for survivors of suicide.
The Oklahoma Strategy is comprehensive and ambitious. To achieve these goals it will be necessary for
Oklahomans at the state and local levels to take action. The strategy calls upon schools, state agencies,
tribes, faith communities, media, health care providers, community coalitions, just to name a few, to
implement portions of the plan. Through continued collaboration and commitment to the strategy, lives
will be saved.| 5
THE PUBLIC HEALTH APPROACH IS WIDELY REGARDED AS THE APPROACH THAT IS MOST LIKELY TO PRODUCE SIGNIFICANT AND SUSTAINED REDUCTIONS IN SUICIDE6 |
RECOGNITION
INTERVENTION
IMPACT| 7
What Causes Suicide?
The causes of suicide are complex and vary among individuals and across age, cultural, racial, and ethnic groups. The risk of suicide is influenced by an array of biological, psychological, social, environmental, and cultural risk factors. • • •
Many people who attempted or completed suicide had one or more warning signs before their death.
While warning signs refer to more immediate signs or symptoms in an individual, risk factors for suicide
are generally longer-term factors that are associated with a higher prevalence of suicide in the population.
Recognition of warning signs has a greater potential for immediate prevention and intervention when
those who are in a position to help know how to appropriately respond.
Feelings of hopelessness and an inability to make positive changes in one’s life are two consistent
psychological precursors to suicidal behaviors. Many of those who die by suicide are described by family or
friends as having been depressed or as having problems with a current or former intimate partner.
Trauma has a significant impact on suicide risk across the life span. A survey of over 17,000 people
found that a history of adverse childhood experiences was associated with a significant increase in the
prevalence of attempted suicides. For example, individuals reporting that their parents had separated
or divorced were twice as likely to have attempted suicide, and those who were emotionally abused
as children were five times as likely to have attempted suicide. For each additional adverse experience,
the risk of attempted suicide increased by about 60 percent. This study also found a high prevalence of
depression and substance abuse, suggesting that a history of adverse childhood experiences is associated
with a host of negative outcomes.
Risk Factors for Suicide
BIOPSYCHOSOCIAL RISK FACTORS
• M ental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
• Alcohol and other substance use disorders
• Hopelessness
• Impulsive and/or aggressive tendencies
• History of trauma or abuse
• Some major physical illnesses
• Previous suicide attempt
• Family history of suicide
SCOPE OF THE PROBLEM8 |
ENVIRONMENTAL RISK FACTORS
• Job or financial loss
• Relational or social loss
• Easy access to lethal means
• Local clusters of suicide that have a contagious influence
SOCIAL/CULTURAL RISK FACTORS
• Lack of social support and sense of isolation
• Stigma associated with help-seeking behavior
• Barriers to accessing health care, especially mental health and substance abuse treatment
• Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution
to a personal dilemma)
• Exposure to, including through the media, and influence of others who have died by suicide
What Protects Against Suicide?
• • •
Protective factors can reduce the likelihood of suicide by counterbalancing some of the risk factors.
Examining populations with lower suicide rates can help understand potential protective factors and
focuses for prevention strategies. Social, political, and economic factors may help explain different rates of
suicide between countries and states. Differences in rates of depressive disorders, alcohol consumption,
proportion of older adults, levels of social isolation, and religiosity may all play a role in the rate of suicide.
In the United States, suicide rates among African American women, particularly in middle age, are very
low. Sociocultural differences between population groups and between individuals, including social connectedness, family relations, marital status, parenthood, and participation in religious activities and
beliefs (including negative moral attitudes toward suicide), may all be important underlying factors.
Protective Factors for Suicide
• Effective clinical care for mental, physical and substance use disorders
• Easy access to a variety of clinical interventions and support for helpseeking
• Restricted access to highly lethal means of suicide
• Strong connections to family and community support
• Support through ongoing medical and mental health care relationships
• Skills in problem solving, conflict resolution and nonviolent handling of disputes
• Cultural and religious beliefs that discourage suicide and support self-preservation| 9
Suicide in Oklahoma
• • •
Oklahoma is ranked 13th highest among all states for the number of suicide deaths per capita. Suicide was
the most prevalent type of violent death in Oklahoma from 2004 to 2007, accounting for 2,057 deaths
(14.4 suicides annually per 100,000 population), an average of 514 deaths per year. The rate of suicide was
stable from 2004 to 2007. In 52 of the suicide deaths, the victim killed at least one other person before
taking his/her own life, resulting in 65 homicide deaths.
TABLE 1.
Suicide by Year
Oklahoma, 2004-2007
Year Number Rate
2004 496 14.1
2005 517 14.6
2006 528 14.8
2007 516 14.3
SUICIDE WAS THE MOST PREVALENT TYPE OF VIOLENT DEATH IN OKLAHOMA FROM 2004-2007
* Per 100,000 population.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent
Death Reporting System, 2004-2007, Injury Prevention Service,
Oklahoma State Department of Health.10 |
TABLE 3.
Gender, Race, and Ethnicity Specific Rates of Suicide
Oklahoma, 2004-2007
■ Male ■ Female
Race/Ethnicity
0
5
10
15
20
25
30
Rate per 100,000 Population
White Native American Black Asian Hispanic Ethnicity
25.9
7.4
24
5.4
10.8
2 2.3 1.5
12.1
3.8
Age
The youngest person to die by suicide was 12
years of age and the oldest person was 96 years.
Seventy-eight percent of suicide victims were
male and 22 percent were female. Males 75-84
years of age had the highest suicide rate among all
ages. Among females, women 35-54 years were
at greatest risk for suicide. White males had the
highest suicide rate (25.9 percent), followed by
Native American males (24.0 percent), black males
(10.8 percent), and Asian males (2.3 percent).
TABLE 2.
Age and Gender Specific Rates of Suicide* Oklahoma, 2004-2007
■ Male ■ Female
0
10
20
30
40
50
60
5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Rate per 100,000 Population
Age Group
1.1 0.4
20.1
4.8
26.8
7
34.3
10.5
32.8
12.2
24.4
8.9
26.9
4.5
47
5.2
45.4
1.7
* Includes 2,057 persons.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System,
2004-2007, Injury Prevention Service, Oklahoma State Department of Health.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System,
2004-2007, Injury Prevention Service, Oklahoma State Department of Health.| 11
TABLE 4. Suicide by Age, Gender, Race,* and Ethnicity**, Oklahoma, 2004-2007
White Black Native American Asian Hispanic
Age Number Rate Number Rate Number Rate Number Rate Number Rate
Both Genders
5-14 12 0.8 1 0.5 2 0.9 0 0.0 3 1.5
15-24 190 11.8 16 7.3 50 20.8 2 4.1 21 12.1
25-34 241 16.1 26 14.7 41 23.5 1 1.8 28 15.0
35-44 358 23.3 14 8.9 41 25.5 1 2.4 15 11.2
45-54 396 23.8 9 6.2 31 20.0 1 3.2 12 14.6
55-64 237 18.1 5 5.9 4 3.8 0 0.0 0 0.0
65-74 135 15.6 2 4.2 6 10.2 0 0.0 1 5.1
75-84 139 23.9 1 3.7 3 9.3 0 0.0 0 0.0
85+ 38 16.2 1 9.1 0 0.0 0 0.0 0 0.0
Total 1,746 15.2 75 6.2 178 14.0 5 1.8 80 8.3
Males
5-14 10 1.5 1 0.9 0 0.0 0 0.0 2 2.0
15-24 153 20.3 12 10.7 43 36.5 2 7.9 17 17.7
25-34 193 29.1 22 25.5 30 36.2 1 3.5 22 20.5
35-44 272 38.5 11 14.8 34 44.5 0 0.0 12 16.3
45-54 282 36.2 9 13.2 25 34.8 0 0.0 9 20.0
55-64 170 27.8 4 10.3 3 6.1 0 0.0 0 0.0
65-74 111 28.4 2 9.9 6 23.0 0 0.0 1 10.6
75-84 120 51.1 1 9.9 3 22.9 0 0.0 0 0.0
85+ 35 49.2 1 30.1 0 0.0 0 0.0 0 0.0
Total Males 1,346 25.9 63 10.8 144 24.0 3 2.3 63 12.1
Females
5-14 2 0.3 0 0.0 2 1.9 0 0.0 1 1.0
15-24 37 5.3 4 4.0 7 6.2 0 0.0 4 5.2
25-34 48 7.3 4 4.8 11 13.1 0 0.0 6 7.5
35-44 86 12.1 3 3.8 7 8.8 1 4.8 3 5.0
45-54 114 14.1 0 0.0 6 7.6 1 5.7 3 8.0
55-64 67 10.2 1 2.2 1 1.8 0 0.0 0 0.0
65-74 24 5.3 0 0.0 0 0.0 0 0.0 0 0.0
75-84 19 5.6 0 0.0 0 0.0 0 0.0 0 0.0
85+ 3 1.9 0 0.0 0 0.0 0 0.0 0 0.0
Total Females 400 7.4 12 2.0 34 5.4 2 1.5 17 3.8
* Race was “mixed” for 2 persons, “other” for 44 persons, and unknown for 7 persons.
** Hispanic ethnicity is counted separately from race and is not a racial category. Hispanic ethnicity was unknown for 17 persons.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.12 |
Suicide Method/Mean
Firearms were used in 59 percent of the suicide deaths, hanging/strangulation
in 19 percent, poisoning in 17 percent, and other methods were used in 5
percent of suicides. Other methods used to complete suicide were sharp/blunt
instrument (30), motor vehicle or other transportation vehicle (27), drowning
(16), fire (16), fall (7), and unknown (2) methods. Firearms were used in male
suicide deaths more often than in female suicide deaths, 66 percent and 40
percent, respectively. Poisoning was used more often in female suicide than
male suicide, 38 percent and 11 percent, respectively.
Circumstances
A substantial number of suicides were associated with a current depressed
mood, intimate partner problem, mental health problem, physical health
problem, and/or crisis in the past two weeks. Circumstances associated with
suicide varied by age. Physical health problems were more often associated
with suicide among persons 65 years and older. Intimate partner problems
were more often associated with suicides of persons less than 65 years of age.
Almost one in five suicide victims had a history of suicide attempts. Thirty
percent had stated their intent or expressed suicidal feeling to another person
and 29 percent left a suicide note.
Seventy-six percent of persons who died by suicide with a current mental
health problem were receiving mental health treatment, including 65 percent
of persons 12-24 years, 77 percent of persons 25-44 years, 80 percent of
persons 45-64 years, and 65 percent of persons 65 years and older.
FIGURE 1.
Method of Suicide by Gender Oklahoma, 2004-2007
Firearm
66%
Hanging/
Strangulation
19%
Poisoning
11%
Sharp/Blunt
Instrument
1% Other
3%
Sharp/Blunt
Instrument
1% Other
5%
Firearm
39%
Hanging/
Strangulation
17%
Poisoning
38%
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent
Death Reporting System, 2004-2007, Injury Prevention Service,
Oklahoma State Department of Health.
Male
Female| 13
TABLE 5. Selected Suicide Circumstances by Gender, Oklahoma, 2004-2007*
Total (n=2,057) Male (n=1,599) Female (n=458)
Number Percent Number Percent Number Percent
Current depressed mood 941 46 731 46 210 46
Intimate partner problem 682 33 551 34 131 29
Disclosed intent to commit suicide 614 30 463 29 151 33
Mental health problem 583 28 396 25 187 41
Depression/dysthymia 281 14 209 13 72 16
Bipolar disorder 76 4 34 2 42 9
Schizophrenia 35 2 26 2 9 2
Anxiety disorder 26 1 16 1 10 2
Post-traumatic stress disorder 5 0 4 0 1 0
Obsessive-compulsive disorder 2 0 2 0 0 0
Eating disorder 1 0 0 0 1 0
Other/unknown 217 11 136 9 81 18
Left a suicide note 601 29 458 29 143 31
Physical health problem 559 27 431 27 128 28
Crisis in past two weeks 505 25 413 26 92 20
History of previous suicide attempts 367 18 223 14 144 31
Substance abuse 278 14 194 12 84 18
Financial problem 241 12 188 12 53 12
Other relationship problem 222 11 161 10 61 13
Alcohol 188 9 155 10 33 7
Job problem 187 9 162 10 25 5
Recent criminal legal problem 179 9 160 10 19 4
Other death of friend or family 139 7 112 7 27 6
Non-criminal legal problem 85 4 70 4 15 3
Perpetrator of interpersonal violence within past month 49 2 44 3 5 1
Suicide of friend or family within past five years 34 2 20 1 14 3
School problem 14 1 11 1 3 1
Victim of interpersonal violence within past month 7 0 3 0 4 1
* More than one circumstance may have been associated with the death. Percentages were calculated using the total number of persons that committed suicide.
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.14 |
TABLE 6. Ten Most Common Circumstances* Associated with Suicide Deaths by Rank and Age Group, Oklahoma, 2004-2007*
Rank
1
2
3
4
5
6
7
8
9
10
12-24 Years
Current depressed mood (41%)
Intimate partner
problem (38%)
Crisis in past 2 weeks
(30%)
Current mental health
problem (22%)
Relationship problem
other than intimate
partner (21%)
Substance abuse
problem (19%)
History of suicide
attempts (19%)
Recent criminal/legal problem (9%)
Job problem (8%)
Financial problem (6%)
25-44 Years
Intimate partner
problem (47%)
Current depressed mood (43%)
Current mental health
problem (31%)
Crisis in past 2 weeks
(28%)
History of suicide
attempts (21%)
Substance abuse
problem (19%)
Recent criminal/legal problem (13%)
Financial problem (12%)
Physical health
problem (12%)
Alcohol problem
(12%)
45-64 Years
Current depressed mood (49%)
Current mental health
problem (31%)
Physical health
problem (31%)
Intimate partner
problem (29%)
Crisis in past 2 weeks
(21%)
History of suicide
attempts (20%)
Financial problem (16%)
Job problem (13%)
Substance abuse
problem (11%)
Alcohol problem (11%)
65+ Years
Physical health
problem (73%)
Current depressed mood (49%)
Crisis in past 2 weeks
(21%)
Current mental health
problem (20%)
Death of family or
friend (13%)
History of suicide
attempts (8%)
Intimate partner
problem (7%)
Financial Problem (6%)
Other relationship
problem (5%)
Alcohol problem (3%)
*More than one circumstance may have been associated with the suicide.
TABLE 11. Suicide Deaths of Veterans by Age, Oklahoma, 2004-2007
Age Number Percent
15-24 18 4%
25-34 30 6%
35-44 53 11%
45-54 77 17%
55-64 90 19%
65+ 198 42%
Total 466 100%
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.| 15
FIGURE 2.
Suicide Death Rates by County of Residence Oklahoma, 2004-2007
Circumstances (Continued)
A positive blood alcohol test was documented for 570 persons (30 percent of
persons tested), and a positive drug test was documented for 393 persons (88
percent of persons tested) who died by suicide.
Twenty-three percent (466) of suicide victims were veterans (persons who had served in the U.S. Armed Forces), including 456 males and 10 females. This represents 76 percent (466/615) of all violent deaths among veterans. The mean age of veterans who committed suicide was 59 years. The youngest victim was 18 and the oldest was 93 years of age; 42 percent of these suicide deaths were among veterans 65 years of age and older. The vast majority (78 percent) of suicides among veterans were completed with a firearm. Other methods of suicide among veterans were poisoning (11 percent), hanging/strangulation (8 percent), and other methods (3 percent). The circumstances most often associated with the veteran suicide were current depressed mood (49 percent), physical health problem (52 percent), crisis in the past two weeks (25 percent), current mental health problem (24 percent), and intimate partner problem (24 percent).
Forty counties had suicide rates higher than the state rate, 36 counties had
suicide rates below the state rate, and in one county there were no suicide
deaths during 2004-2007.
Ideation
The percentage of Oklahoma students who felt
sad and hopeless almost every day for two weeks
or more in a row was down in 2007 compared
to 2003 and 2005. Overall, about one-fourth of
students felt sad or hopeless almost every day for
two or more weeks in a row. Tenth grade females
reported the highest percentage of feeling sad or
hopeless almost every day for two or more weeks
in a row. Ninth grade females reported the highest
percentage of students who seriously considered
suicide. Overall, over one in 10 students reported
they had seriously considered suicide.
Economic Costs
The average medical cost per incident of
hospitalized suicide attempt in 2006 was $7,995,
and the average work loss per case of hospitalized
suicide attempt was $9,213. For suicide deaths, the
average medical cost per incident was $3,908. The
average work loss per case of suicide death was
$1.08 million.
■ 50+% Above State Rate
■ 25-49% Above State Rate
■ 1-24% Above State Rate
■ Below State Rate
■ No Deaths
Source: Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, 2004-2007, Injury Prevention Service, Oklahoma State Department of Health.16 |
STRATEGY
GOALS
PREVENTION| 17
Goal 1
Promote awareness that suicide is a public health problem that is preventable. • • •
Rationale:
The stronger and broader the support for a public health initiative, the greater its chance for success. If
the general public understands that suicide and suicidal behaviors can be prevented, and people are made
aware of the roles individuals and groups can play in prevention, the suicide rate can be reduced.
Objectives for Action:
OBJECTIVE 1.1 Implement a minimum of one public information campaign, designed to increase public knowledge of suicide prevention, in all 77 counties of Oklahoma.
OBJECTIVE 1.2 The state suicide prevention council will foster collaboration with stakeholders
on prevention strategies across disciplines and with the public.
OBJECTIVES FOR ACTION
SUICIDE IS A PUBLIC HEALTH PROBLEM THAT IS PREVENTABLEGoal 2:
Develop broad-based support for suicide prevention. • • •
Rationale:
Collaboration across a broad spectrum of agencies, institutions, and groups is a way to ensure that
prevention efforts are comprehensive. Such collaboration can also generate greater and more effective
attention to suicide prevention than can these groups working alone. Broad-based support for suicide
prevention may also lead to additional funding and to the incorporation of suicide prevention activities
into organizations that have not previously addressed it.
Objectives for Action:
OBJECTIVE 2.1 Sustain funding for an Office of Suicide Prevention within the Department
of Mental Health and Substance Abuse Services to serve as an ongoing,
centralized coordination of suicide prevention activities across the state.
OBJECTIVE 2.2 Ensure that existing Oklahoma community coalitions have information about
suicide, prevention strategies and training opportunities.
OBJECTIVE 2.3 Ensure that state agencies have information about suicide, prevention
strategies and training opportunities.
OBJECTIVE 2.4 Ensure that institutes of higher learning have information about suicide,
prevention strategies and training opportunities.| 19
Goal 3:
Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services.
• • •
Rationale:
Suicide is closely linked to mental illness and to substance abuse; and effective treatments exist for
both. However, the stigma of mental illness and substance abuse prevents many persons from seeking
assistance. The stigma of suicide itself–the view that suicide is shameful and/or sinful–is also a barrier to
treatment for persons who have suicidal thoughts or who have attempted suicide. Family members of
suicide attempters often hide the behavior from friends and relatives, and those who have survived the
suicide of a loved one suffer not only the grief of loss, but often the added pain stemming from stigma.
Stigma associated with mental illness, substance abuse, and suicide has resulted in the establishment of
separate systems for physical and mental health care. One consequence is that preventive services and
treatment for mental illness and substance abuse are much less available than for other health problems.
Destigmatizing mental illness, substance use disorders and suicide could increase access to treatment by
integrating care and increasing the willingness of individuals to seek treatment.
Objectives for Action:
OBJECTIVE 3.1 Increase the proportion of the public that views mental and physical health as
equal, inseparable components of overall health.
OBJECTIVE 3.2 Increase the proportion of Oklahomans with suicidal ideations or related conditions who seek mental health treatment services by promoting and increasing the capacity of Oklahoma’s center for the National Suicide Prevention Lifeline and referrals to services.
THE STIGMA OF MENTAL ILLNESS AND SUBSTANCE ABUSE PREVENTS MANY PERSONS FROM SEEKING ASSISTANCE20 |
EFFECTIVE SUICIDE PREVENTION PROGRAMS REQUIRE COMMITMENT AND RESOURCES
Goal 4:
Develop and implement community-based suicide prevention programs. • • •
Rationale:
Research has shown that many suicides are preventable; however, effective suicide prevention programs
require commitment and resources. Effective prevention strategies may include:
• Training for key gatekeepers (people who regularly come into contact with individuals or families in
distress) to recognize risk factors and intervene;
• S creening for suicide risk; and/or
• Promotion of coping and other life skills that develop help-seeking behavior and resilience.
The objectives established for this goal are designed to foster planning and program development work
and to ensure the integration of evidence-based suicide prevention within key organizations and sectors of
the community that have access to groups of individuals who otherwise might not receive the information. Objectives for Action:
OBJECTIVE 4.1 Increase the proportion of counties in Oklahoma with comprehensive
suicide prevention plans. All 77 counties should have a plan in place.
OBJECTIVE 4.2 Increase the proportion of school districts, private school associations, and
tribal schools, with evidence-based strategies designed to address serious
childhood and adolescent distress to prevent suicide.
OBJECTIVE 4.3 Increase the proportion of colleges and universities with evidence-based strategies designed to address serious young adult distress to prevent suicide.
OBJECTIVE 4.4 Increase the proportion of employers that ensure the availability of
evidence-based prevention strategies for suicide.
OBJECTIVE 4.5 Increase the proportion of correctional institutions, jails and detention
centers housing either adult or juvenile offenders, with evidence-based
suicide prevention strategies.
OBJECTIVE 4.6 Increase the proportion of state aging networks that have evidence-based
suicide prevention strategies designed to identify and refer for treatment
elderly people at risk for suicidal behavior.
OBJECTIVE 4.7 Increase the proportion of family, youth and community service providers
and organizations with evidence-based suicide prevention strategies.
OBJECTIVE 4.8 Increase the proportion of faith based organizations with evidence-based
suicide prevention strategies.
OBJECTIVE 4.9 Increase the proportion of primary health care organizations and providers
with evidence-based suicide prevention strategies.
OBJECTIVE 4.10 Increase the proportion of tribes with evidence-based suicide prevention
strategies.
OBJECTIVE 4.11 Increase the proportion of counties (or comparable jurisdictions such as
cities or tribes) in which education programs are available to family members
and others in close relationships with those at risk for suicide.22 |
Goal 5:
Promote efforts to reduce access to lethal means and methods of self-harm.
• • •
Rationale:
Evidence shows that limiting access to lethal means of self-harm may be an effective strategy to prevent
self-destructive behaviors. Often referred to as “means restriction,” this approach is based on the
belief that a small, but significant minority of suicidal acts are, in fact, impulsive and of the moment;
they result from a combination of psychological pain or despair coupled with the easy availability of
the means by which to inflict self-injury. Thus, a self-destructive act may be prevented by limiting the
individual’s access to the means of self-harm. Evidence suggests that there may be a limited time effect
for decreasing self-destructive behaviors in susceptible and impulsive individuals when access to the
means for self-harm is restricted. The objectives established for this goal are designed to separate the
suicidal impulse from access to lethal means of self-harm.
Objectives for Action:
OBJECTIVE 5.1 Increase the proportion of primary care clinicians, other health care
providers, and health and safety officials who routinely assess the presence
of lethal means (including firearms, drugs, and poisons) in the home and
educate about actions to reduce associated risks.
OBJECTIVE 5.2 Initiate a targeted public awareness campaign for guns and medications
safety to expose a larger proportion of households designated to reduce the
accessibility of lethal means, including firearms and medications, in the home.
OBJECTIVE 5.3 Initiate a gun lock or exchange your lock program in partnership with other
state agencies.
OBJECTIVE 5.4 Develop guidelines for safer dispensing of medications for individuals at
heightened risk of suicide.| 23
A SELF-DESTRUCTIVE ACT MAY BE PREVENTED BY LIMITING THE INDIVIDUAL’S ACCESS TO THE MEANS OF SELF-HARM24 |
Goal 6:
Develop and promote effective clinical and professional practices.
• • •
Rationale:
One way to prevent suicide is to identify individuals at risk and to engage them in treatments that are
effective in reducing the personal and situational factors associated with suicidal behaviors (e.g., depressed
mood, hopelessness, helplessness, alcohol and other drug abuse, etc.). Another way to prevent suicide
is to promote and support the presence of protective factors, such as learning skills in problem solving,
conflict resolution, and nonviolent handling of disputes. By improving clinical practices in the assessment,
management, and treatment of individuals at risk for suicide, the chances for preventing those individuals
from acting on their despair and distress in self-destructive ways are greatly improved. Moreover,
promoting the presence of protective factors for these individuals can contribute importantly to reducing
their risk. The objectives established for this goal are designed to heighten awareness of the presence
or absence of risk and protective conditions associated with suicide, leading to better triage systems and
better allocation of resources for those in need of specialized treatment.
ONE WAY TO PREVENT SUICIDE IS TO IDENTIFY INDIVIDUALS AT RISK AND TO ENGAGE THEM IN TREATMENTS THAT ARE EFFECTIVEObjectives for Action:
OBJECTIVE 6.1 Promote guidelines for assessment of suicide risk among persons receiving care in primary health care
settings, emergency departments, and specialty mental health and substance abuse treatment centers.
OBJECTIVE 6.2 Increase the proportion of specialty mental health and substance abuse treatment centers that have
policies, procedures, and training for all staff designed to assess suicide risk and intervene to reduce
suicidal behaviors among their patients.
OBJECTIVE 6.3 Encourage aftercare treatment and referrals for individuals exhibiting suicidal behavior and ideation (including those discharged from inpatient facilities and hospitals).
OBJECTIVE 6.4 Train those who provide key services to suicide survivors (e.g., emergency medical technicians,
firefighters, law enforcement officers, funeral directors, clergy, medical examiners) to addresses their
own (the service provider) exposure to suicide in addition to the unique needs of suicide survivors.
OBJECTIVE 6.5 Develop and disseminate informational materials to individuals and agencies that routinely provide immediate post-trauma psychological support and mental health education for all victims of sexual
assault and/or physical abuse (e.g., law enforcement, hospital emergency departments, crisis
intervention works, sexual assault nurse examiners, emergency shelter workers, etc).
OBJECTIVE 6.6 Develop and disseminate information and materials providing education to family members and
significant others of persons receiving care who may be at risk of suicide. Implement the guidelines
in facilities (including those in general and psychiatric hospitals, community mental health clinics, and
substance abuse treatment facilities).
OBJECTIVE 6.7 Promote screening for depression, substance abuse and suicide risk as a minimum standard of care for
assessment in primary care settings, hospice, and skilled nursing facilities.
OBJECTIVE 6.8 Increase the number of recertification or licensing programs in relevant professions that require or
promote competencies in depression assessment and management and suicide prevention.
OBJECTIVE 6.9 A legislative mandate shall be in place requiring all professional licensing agencies to require continuing
education on suicide prevention each year for licensure.
OBJECTIVE 6.10 Oklahoma shall have at least two certified suicide prevention trainers in each county at all times, the
number required will be proportionate to the population size.
OBJECTIVE 6.11 Oklahoma shall have a 24/7 aftercare and postvention team of personnel created and trained regionally to:
• Provide support after a death by suicide.
• Prevent additional deaths among survivors and the immediate community.
• Collect information regarding the proceeding circumstances to inform future suicide
prevention practices.26 |
Goal 7:
Increase access to and community linkages with mental health and substance abuse services.
• • •
Rationale:
Barriers to equal access and affordability of health care may be influenced by financial, structural, and personal factors. Financial barriers include not having enough health insurance or not having the financial capacity to pay for services outside a health plan or insurance program. Structural barriers include the lack of primary care providers, medical specialists or other health care professionals to meet special needs or the lack of health care facilities. Personal barriers include cultural or spiritual differences, language, not knowing when or how to seek care, or concerns about confidentiality or discrimination. Reducing disparities is a necessary step in ensuring that all Americans receive appropriate physical health, mental health, and substance abuse services. One aspect of improving access is to better coordinate the services of a variety of community institutions. This will help ensure that at-risk populations receive the services they need, and that all community members receive regular preventive health services. The objectives established for this goal are designed to enhance inter-organizational communication to facilitate the provision of health services to those in need of them.
Objectives for Action:
OBJECTIVE 7.1 Develop and disseminate guidelines for schools on appropriate linkages with
mental health and substance abuse treatment services and implement those
guidelines in a proportion of school districts.
OBJECTIVE 7.2 Increase the number of school districts that have a formalized relationship
with mental health and substance abuse providers.
OBJECTIVE 7.3 Increase the number of mental health courts to one in every county in
Oklahoma.
OBJECTIVE 7.4 Increase the proportion of counties (or comparable jurisdictions) in
which the guidelines for effective suicide survivor support programs are
implemented.
OBJECTIVE 7.5 Increase the proportion of counties (or comparable jurisdictions) with
health and/or social services outreach programs for at-risk populations that
incorporate mental health services and suicide prevention.
OBJECTIVE 7.6 Identify strategic locations and information to link people to services and
offer referrals for crisis interventions.
OBJECTIVE 7.7 Develop an active survivor of suicide support group in every county.| 27
Goal 8:
Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in the entertainment and news media.
• • •
Rationale:
The media can have a powerful impact on perceptions of reality and behavior. Research over many
years has found that media representations of suicide may increase suicide rates, especially among youth.
“Cluster suicides” and “suicide contagion” have been documented, and studies have shown that both news
reports and fictional accounts of suicide can lead to increases in suicide. On the other hand, it is widely
acknowledged that the media can play a positive role in suicide prevention. The way suicide is presented is
particularly important. Media portrayals of mental illness and substance abuse may also affect the suicide
rate. Negative views of these problems may lead individuals to deny they have a problem or be reluctant
to seek treatment—and untreated mental illness and substance abuse are strongly correlated with suicide.
The objectives established for this goal are designed to foster consideration among media leaders of the
impact of different styles of describing or otherwise depicting suicide and suicidal behavior, mental illness,
and substance abuse, and to encourage media representations of suicide that can help prevent rather than
increase suicide.
Objectives for Action:
OBJECTIVE 8.1 Increase the number of journalism schools that include in their curricula
guidance on the appropriate portrayal and reporting of mental illness, suicide
and suicidal behaviors.
OBJECTIVE 8.2 Increase the proportion of Oklahoma media outlets that actively participate
in promoting accurate and responsible depiction of suicidal behavior, mental
illness and related issues.
OBJECTIVE 8.3 Increase the number of Oklahoma media outlets that are following and have
available the national guidelines for responsible reporting of deaths by suicide.
THE MEDIA CAN HAVE A POWERFUL IMPACT ON PERCEPTIONS OF REALITY AND ON BEHAVIOR28 |
THE VOLUME OF RESEARCH ON SUICIDE AND ITS RISK FACTORS HAS INCREASED CONSIDERABLY IN THE PAST DECADE AND HAS GENERATED NEW QUESTIONS| 29
Goal 9:
Promote and support research on suicide and suicide prevention.
• • •
Rationale:
The volume of research on suicide and its risk factors has increased considerably in the past
decade and has generated new questions about why individuals become suicidal or remain suicidal.
Important contributions of underlying mental illness, substance abuse, and biological factors, as well
as potential risk that comes from certain environmental influences are becoming clearer. Increasing
the understanding of how individual and environmental risk and protective factors interact with each other to affect an individual’s risk for suicidal behavior is the next challenge. This understanding can
contribute to the limited but growing information about how modifying risk and protective factors
changes outcomes pertaining to suicidal behavior.
The objectives established for this goal are designed to support a wide range of research endeavors
focused on the etiology, expression, and maintenance of suicidal behaviors across the lifespan. The
enhanced understanding to be derived from this research will lead to better assessment tools,
treatments, and preventive interventions.
Objectives for Action:
OBJECTIVE 9.1 Develop an Oklahoma suicide research agenda with input from survivors,
practitioners, researchers, and advocates.
OBJECTIVE 9.2 Establish funding (public and private) for suicide prevention research, for
research on translating scientific knowledge into practice, and for training of
researchers in suicidology.
OBJECTIVE 9.3 Require Oklahoma suicide prevention efforts to include research-based
prevention activities that have demonstrated effectiveness for suicide or
suicide behaviors.
OBJECTIVE 9.4 Conduct at least one scientific evaluation study on new or existing suicide
prevention interventions.
OBJECTIVE 9.5 Develop and measure the effectiveness of suicide prevention efforts in
high-risk populations (e.g., older adults; veterans; rural Oklahomans; non-
Hispanic White or Native American race; males; those in prison/jail; persons
who are gay, lesbian, bisexual, transgender; persons who have experienced
post-emergency situations.).
OBJECTIVE 9.6 Conduct five cultural analyses, pilot studies, and/or qualitative studies to
better understand the cultural scripts/processes for suicide and suicide
prevention in Oklahoma’s various cultural groups and populations.30 |
Goal 10:
Improve and expand suicide surveillance systems.
• • •
Rationale:
Surveillance has been defined as the systematic and ongoing collection of data. Surveillance systems
are key to health planning. They are used to track trends in rates, to identify new problems, to provide
evidence to support activities and initiatives, to identify risk and protective factors, to target high risk
populations for interventions, and to assess the impact of prevention efforts. Accurate data on suicide
and suicidal behavior are needed at the State and local levels. State and local data help establish local
program priorities and are necessary for evaluating the impact of suicide prevention strategies. The
objectives established for this goal are designed to enhance the quality and quantity of data available on
suicide and suicidal behaviors and ensure that the data are useful for prevention purposes.
Objectives for Action:
OBJECTIVE 10.1 Refine standardized protocols for death scene investigations and implement
these protocols in the 10 Oklahoma counties with the highest suicide rates.
OBJECTIVE 10.2 Increase the number of psychological autopsy investigations on completed
suicides.
OBJECTIVE 10.3 Obtain 100 percent participation of hospitals (including emergency
departments) that collect uniform and reliable data on suicidal behavior by
accurately coding external cause of injuries, utilizing the categories included
in the International Classification of Diseases.
OBJECTIVE 10.4 Maintain participation in the National Violent Death Reporting System that
includes suicides and collects information not currently available from death
certificates (i.e., psychological autopsies).
OBJECTIVE 10.5 Increase the number of jurisdictions that produce annual reports on
suicide and suicide attempts, integrating data from multiple Oklahoma data
management systems.
OBJECTIVE 10.6 Explore mandating reports on suicide attempts to the Oklahoma State
Department of Health.
OBJECTIVE 10.7 Increase the number of surveys (e.g., across the lifespan, rural/urban/tribal
areas, college students, emergency department patients, primary care
patients, Veterans) that include questions on suicidal behavior.
Objective 10.8: Develop user-friendly web site to distribute data to appropriate parties and
professionals.| 31
Goal 11:
Provide support for survivors of suicide.
• • •
Rationale:
Every year about 500 Oklahomans of all ages die by suicide. Each of these tragic deaths immediately
affects five to eight close relatives. Friends and co-workers are also profoundly affected by each of these
losses. Support to the survivors decreases the risk of the contagion effects of suicide or cluster events.
Objectives for Action:
OBJECTIVE 11.1 Promote and support a network of support groups across the state.
OBJECTIVE 11.2 Promote and support basic guidelines, curriculum and training as
recommended by the American Foundation for Suicide Prevention.
EVERY YEAR ABOUT 500 OKLAHOMANS OF ALL AGES DIE BY SUICIDE.32 |
Contagion
A phenomenon whereby susceptible persons
are influenced towards suicidal behavior through
knowledge of another person’s suicidal acts
Gatekeeper
Individuals trained to identify persons at risk of
suicide and refer them to treatment or supporting
services as appropriate
Ideation
Thoughts of engaging in suicide-related behavior
Means
The instrument or object whereby a self-
destructive act is carried out (i.e., firearm, poison,
medication)
Postvention
A strategy or approach that is implemented after a
crisis or traumatic event has occurred
Prevention
A strategy or approach that reduces the likelihood
of risk of onset, or delays the onset of adverse
health problems or reduces the harm resulting
from conditions or behaviors
Protective factors
Factors that make it less likely that individuals
will develop a disorder; protective factors may
encompass biological, psychological or social factors in the individual, family and environment
Risk factors
Factors that make it more likely that individuals will
develop a disorder; risk factors may encompass
biological, psychological or social factors in the
individual, family and environment
Screening
Administration of an assessment tool to identify
persons in need of more in-depth evaluation or
treatment
Suicide
Death from injury, poisoning, or suffocation where
there is evidence that a self-inflicted act led to the
person’s death
Suicide attempt
A potentially self-injurious behavior with a nonfatal
outcome, for which there is evidence that the
person intended to kill himself or herself; a suicide
attempt may or may not result in injuries
Survivor
Family members, significant others, or
acquaintances who have experienced the loss of
a loved one due to suicide; sometimes this term is
also used to mean suicide attempt survivors
GLOSSARY OF FREQUENTLY USED TERMSOKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
www.ok.gov/odmhsas/Prevention_Programs/
OKLAHOMA STATE DEPARTMENT OF HEALTH (OSDH) www.ok.gov/health/ NATIONAL SUICIDE PREVENTION LIFELINE www.suicidepreventionlifeline.org/
NATIONAL SUICIDE PREVENTION LIFELINE - VETERANS www.suicidepreventionlifeline.org/Veterans/
SAVE | SUICIDE AWARENESS VOICES OF EDUCATION www.save.org/
AMERICAN ASSOCIATION OF SUICIDOLOGY
www.suicidology.org/ AMERICAN FOUNDATION FOR SUICIDE PREVENTION
www.afsp.org/ SUICIDE PREVENTION RESOURCE CENTER (SPRC) www.sprc.org/
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) mentalhealth.samhsa.gov/suicideprevention/ NIMH | NATIONAL INSTITUTE FOR MENTAL HEALTH
www.nimh.nih.gov
CDC | CENTERS FOR DISEASE CONTROL AND PREVENTION www.cdc.gov/violenceprevention/suicide/ WHO | WORLD HEALTH ORGANIZATION
www.who.int/topics/suicide/
UNITED STATES DEPARTMENT OF VETERANS AFFAIRS
OFFICE OF MENTAL HEALTH SERVICES (OMHS) www.mentalhealth.va.gov/suicide_prevention/
SUICIDE.ORG
SPAN USA | SUICIDE PREVENTION ACTION NETWORK USA www.spanusa.org/
ARMY G-1 SUICIDE PREVENTION www.preventsuicide.army.mil/
NAVY SUICIDE PREVENTION
www.suicide.navy.mil/ RESOURCESOKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
www.ok.gov/odmhsas/
This publication was printed by University Printing Services for the Oklahoma Department of Mental Health and Substance Abuse Services and developed [in part] with funding from grant number SM-57394, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). 300 copies of the publication were produced at a cost of $2623.00. No state appropriated funds were utilized for printing or production. The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. Copies of the publication have been deposited with the Oklahoma Department of Libraries, Publication’s Clearinghouse. (03/2011)